Background: Third-year medical students during their internal medicine clerkship may be predisposed to short sleep duration (<7 h of sleep per night) because of rigorous clinical schedules and academic demands.

Even before the coronavirus disease (COVID-19) pandemic, burnout in healthcare providers had reached crisis levels, with up to 50% of nurses and 40% of physicians experiencing symptoms of burnout. Because of the immense work-related stress during the pandemic, healthcare providers’ burnout dramatically escalated, with percentages reaching as high as 70–90%, and many healthcare providers started to leave their profession. As a result, patients are beginning to experience the deleterious impact of extreme staffing shortages in healthcare facilities. Burnout interventions are defined as either organizational or individually focused. Organizational interventions address problems such as electronic medical records, documentation, or billing systems. Individual interventions provide the necessary skills to address specific job-related stressors. Ideally, the most effective interventions would combine these two categories by teaching healthcare providers to cope with job-related stressors in a safe community that is supported by the healthcare organization. The adoption of combined organizational and individual programs will improve healthcare providers’ job satisfaction, decrease burnout and other forms of psychological distress, enhance job retention, and return joy to healthcare. The resulting decreased turnover rates would also reduce some of the skyrocketing healthcare costs, as turnover is expensive for healthcare organizations. Ultimately, enhancing healthcare providers’ well-being would improve the care we deliver to our patients. In this article, I explain why it is a critical time in healthcare and highlight four general principles that frame the development of specific well-being interventions. Finally, I discuss several interventions that could enhance the well-being of healthcare providers and ultimately transform the culture of healthcare.

J.K.L. received salary support from research funding by American Heart Association grant 23CDA1052352 and the National Scleroderma Foundation paid to Boston University. J.K.L. also received salary support from the Boston University Department of Medicine Career Investment Award.

The medical student clerkship experience is not just about practical application of knowledge learned in the pre-clerkship years. Starting on the first day in the clinical learning environment, students will start to learn, through both implicit and explicit lessons, which behaviors are frowned upon and which are rewarded, how they should prioritize the varying demands of the day, how to balance their personal and professional lives, and much more.

Gupta and colleagues (pp. 179–190) have explored an important question about the potential impact of interventional pulmonology (IP) fellowships on bronchoscopy training of pulmonary and critical care medicine (PCCM) fellows in the study “Effect of Interventional Pulmonology Fellowships on Pulmonary Critical Care Fellows’ Core Bronchoscopy Competencies” published in this issue of ATS Scholar (1). They conducted a multicenter prospective cohort assessment comparing basic bronchoscopy skill acquisition longitudinally measured using the Ontario Bronchoscopy Assessment Tool (OBAT) in pulmonary and critical care fellowship programs with and without IP fellowship programs to begin to explore their hypothesis that PCCM fellows at institutions without IP fellowships may have greater basic bronchoscopy competency than PCCM fellows at institutions with IP fellowship programs because of hands-on volume and whether there is any potential impact of IP training programs on PCCM fellowship bronchoscopy training. Although programs studied included both those with and without IP fellowship programs, this study is significantly limited by the small number of programs (2 with IP training programs and 3 without IP training programs) in the context of 44 existing IP fellowship programs in the United States, as well as a lack of heterogeneity geographically of the selected programs. Using the OBAT, the investigators compared basic bronchoscopy skill acquisition longitudinally among first-, second-, and third-year PCCM fellows and noted higher scores that were statistically significant in the second year among those in programs without IP training programs (mean [standard deviation], 4.25 [0.5]) compared with programs with IP training program (mean [standard deviation], 3.48 [0.4]) (P = 0.006), hypothesizing that those without IP fellowships may have more access to higher volumes of bronchoscopy and an increased likelihood of performing the procedure rather than participating more observationally. Nonetheless, all learners, by the completion of their third year as PCCM fellows, achieved basic bronchoscopy competency by that measure in programs both with and without IP fellowship programs.

Reducing waste in government spending is a laudable cause. It gives us the opportunity to put our money where it is needed most and where it has the most positive impact. The true challenge is how to eliminate waste while maintaining and even enhancing programs that are vital to the health of our country.

Definition of abbreviations: PAC = pulmonary artery catheter; PGY = post-graduate year; SD = standard deviation.